Healthcare Provider Details

I. General information

NPI: 1407376346
Provider Name (Legal Business Name): MICHAEL JOSEPH RIPPLE MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL # 3S34
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

1 CHILDRENS PL # 3S34
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6006
  • Fax: 314-454-4102
Mailing address:
  • Phone: 314-454-6006
  • Fax: 314-454-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2017019513
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: